Healthcare Provider Details

I. General information

NPI: 1609909779
Provider Name (Legal Business Name): EUGENE D HALL PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MARINER HEALTH WAY
ST AUGUSTINE FL
32086-3215
US

IV. Provider business mailing address

2222 SULLIVAN TRL
EASTON PA
18040-7958
US

V. Phone/Fax

Practice location:
  • Phone: 610-991-2034
  • Fax: 610-438-2046
Mailing address:
  • Phone: 610-991-2034
  • Fax: 610-438-2046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: